Provider Demographics
NPI:1194781872
Name:LEE, DAVID YOON (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:YOON
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:812-353-2800
Mailing Address - Fax:
Practice Address - Street 1:2620 COTA DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4211
Practice Address - Country:US
Practice Address - Phone:812-353-2800
Practice Address - Fax:812-335-9569
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052638A2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00265188OtherRAILROAD MEDICARE
IN200322640Medicaid
IN300119154OtherRAILROAD MEDICARE
IN980210ZMedicare PIN
IN542650ZMedicare PIN
H24739Medicare UPIN
INP00265188OtherRAILROAD MEDICARE